Examining Low Back Pain Treatment as an Emergency Room Physician

September 20, 2023

Article was written by:

Maria Granzotti MD MBA CPE CHCQM FACHE FABQAURP, Chief Medical Officer, WholeHealth Living

Nearly 65 million Americans report a recent episode of back pain with an economic impact of $12 billion a year in health care and indirect costs. It is the sixth most costly medical condition in America.1

Having practiced Emergency Medicine for over twenty years, I have experienced first-hand those suffering from low back pain seeking treatment in Emergency Rooms. In fact, low back pain is the most common reason for non-urgent emergency department visits.2

I can truly appreciate the care value demonstrated in recent research “Association Between Chiropractic Spinal Manipulation and Emergency Visits in Adults With Non-urgent Low Back Pain: Retrospective Cohort Study.”2 The study examined the association between receiving chiropractic spinal manipulative therapy and emergency department utilization. Conducted by utilizing a larger national electronic health records-based network, it focused on those 18-89 with incident non-urgent low back pain segmented by those who received chiropractic spinal manipulation therapy and those who had not, then examined the data to see which patients had a low back related emergency department visit within 1-year follow up. Urgent and emergent low-back related diagnoses were excluded from both groups data.

This research showed essentially, chiropractic spinal manipulative therapy as a first line option for new low back pain in the absence of urgent complaints reduced the likelihood of subsequent ER visits for 12 months of follow up.

This is not the only research of its kind – the evidence continues to roll in supporting the efficacy of integrative health in treating MSK conditions and the associated pain. We are witnessing a shift that clinicians, patients and health plans should consider a non-pharmacological, non-operative approach first in treating MSK and pain. It is exciting to see the broader medical community share in their support the use of integrative health. Many well-known entities like AMA, American College of Physicians, Joint Commission, CDC and CMS have come out in support of non-pharmacological alternatives like chiropractic care, acupuncture, massage therapy and movement therapy as a first line of care. 

But are we doing enough to transform the delivery model to drive positive health outcomes while lowering medical spend? 

Ensuring members have access to integrative health benefits is just the first step.  A comprehensive strategy that includes education to the healthcare consumer is imperative in the behavior change of seeking care for MSK conditions, like lower back pain. When not understanding the benefits of integrative health, or not having access due to the lack of coverage, patients tend to do what they have always done – run to the ER or schedule an appointment with their PCP.  And the cycle begins: opioids, imaging, specialist, surgery.

Another important element is increasing awareness in the Primary Care Physician (PCP) community of the benefits of integrative health as a first line treatment to MSK pain. Integrative health gives PCP’s a way to help treat their MSK patients with an outcome-proven approach that is non-invasive, non-pharmacological and cost-effective. At WholeHealth Living, we work to educate our partnering PCP communities about integrative health’s many benefits. They also know that when they send their patients to our network of integrative health practitioners, their patient is seen by an experienced, licensed and credentialed integrative health practitioner.  

Lastly, we should take a closer look at how we give broader access to covered integrative health benefits. Is the benefit built to decrease the member pay portion, or are we inadvertently driving members to higher cost care because of the barriers we have not overcome – education, access and reasonable or no out-of-pocket expenses. We, at WholeHealth Living, are opening the door to more comprehensive integrative healthcare options, to assist in driving health outcomes and lowering medical spend by decreasing unnecessary imaging, inappropriate specialist referrals, costs and side effects of the over prescribing of opioids with unnecessary emergency visits.

[1] B. Druss, Marcus, S., Olfson, M., and Pincus, H.A. (2002). “The Most Expensive Medical Conditions in America.” Health Affairs, 21(4): 105-111.

[2] Trager, Robert & Vincent, David & Schlick, Kayla & Perez, Jaime & Dusek, Jeffery. (2021). The Association Between Chiropractic Spinal Manipulation and Emergency Department Visits in Adults With Non-urgent Low Back Pain: A Retrospective Cohort Study Protocol.